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A. Gabrielian, S. M. Hariprasad; Incidence of Secondary Glaucoma Following Silicone Oil Use After Vitrectomy Surgery: A Retrospective Chart Review. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1738.
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To evaluate incidence of silicone oil induced glaucoma(SOIG) after 1000cs silicone oil(SO) implantation in patients requiring SO tamponade (SOT) after pars plana vitrectomy(PPV).
Retrospective chart review of patients with SOT for various etiologies (tractional/rhegmatogenous detachments, proliferative vitreoretinopathy, macular holes) from 2005-2008. All underwent air-fluid exchange upon SO removal. Patients with SO overfill were excluded. All had small fluid menisci. Main outcome was SOIG in the operated eye, defined as elevated IOP requiring therapy. Patients who developed SOIG were compared to those who did not. Family history(FH), length of SOT, and IOP outcomes were compared. Patients with IOP spikes post-op (day1-21) were excluded. Ocular hypertension and glaucoma(GLC) patients/suspects were excluded.
50 patients meeting the criteria were evaluated. Average age was 43.5. Mean follow-up was 21mo(range 6→60mo). 11/50(22%) had FH of GLC. Average length of SOT was 8.2mo(range 4-38mo). 11/50(22%) retained SO droplets in anterior segment (AS). Average IOP increased by 3.5mmHg(p=0.0002) post-op. 16/50(32%) developed SOIG. Average time to develop it was 9.7mo(range 1-38mo). 13/16(81%) had persistent SOIG even after SO removal, and 3/13(23%) had SO droplets in AC. 34/50(68%) did not develop SOIG. 6/34(18%) had FH of GLC vs. 5/16 (31%) in SOIG group. Average length of SOT was 7.3mo(range 3-17mo) vs. 10mo(range 3-38mo) in SOIG group. Average IOP in the former group increased by 1.3mmHg(p=0.08) vs. 8.2mmHg in SOIG group(p=0.0001). SOIG group was older (50.5[range 1-73yo] vs. 40.2[range 6-75yo]). SOIG resolved in 1 patient with SO droplets in AC after AC washout. Otherwise, SOIG was managed medically.
1000cs SOT after PPV was associated with development of SOIG in 34%, mostly after post-op month #3, and persisting after SO removal. 31% with SOIG had FH of GLC. SOIG group was older. Retained SO droplets in AS did not predispose to higher rate of SOIG. AC washout was done in 1 patient with resolution of SOIG. The rest were managed medically. All had increased IOP post-op, SOIG group more. Given the success of AC washout in resolving SOIG, perhaps it should be employed in all patients upon SO removal. It would be plausible to investigate 1000 vs. 5000cs SOT in prospective randomized controlled studies, to determine if SOIG incidence is different with 5000cs SO use.
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